Apparatus for the injection of radioopaque liquid in angiography



pri 1967 T. R. MARSHALL APPARATUS FOR THE INJECTION OF RADIO -OPAQUELIQUID IN ANGIOGRAPHY Filed Nov. 6, 1963 2 Sheets-Sheet 1 INVENTOR-THOMAS R. MARSHALL ATTORNEY April 11, 3937 T. R. MARSHALL 3,313,291

APPARATUS FOR THE INJECTION OF RADIO-OPAQUE LIQUID IN ANGIOGRAPHY FiledNov. 6, 1963 l v 2 Sheets-Sheet 2 I I I L 4% 5/ F75, 6 INVENTOR. I4THOMAS R. MARSHALL United States Patent 3,313,291 APPARATUS FOR THEINJECTION 0F RADIO- OPAQUE LIQUID IN ANGIOGRAPHY Thomas R. Marshall,Louisville, Ky., assiguor to Sigmamotor, Inc., village of Middleport,N.Y., a corporation of New York Filed Nov. 6, 1963, Ser. No. 321,884 9Claims. (Cl. 128-2) This invention relates to an apparatus for use inangiography and aortography. More specifically, this invention relatesto an apparatus whereby one or more injections of radio-opaque liquidcan be made without the use of a catheter and without reloading thesyringe.

in order to obtain a good radiological contrast, it is necessary toutilize a radio-opaque substance in sufiicient amount to reach a certaindegree of concentration in the blood. Such radio-opaque substances areiodine deriva- .tives which absonb X-rays and consequently are oftenreferred to as contrast materials. The injections must be made veryrapidly in order that the contrast material move in the form of a bolusto the desired area. It is thus necessary to use sufiicient pressure toovercome the blood pressure in the brachial artery or other site ofinjection so as to move against the flow of blood to the desired area ofthe vascular system. It has been found that in many instances it isnecessary to utilize as high as 400 p.s.i. injection pressure in orderto insure that a suificient quantity of contrast material reaches thedesired area in sufiicient concentration for radiological examination.

In an article by T. R. Marshall and J. T. Ling in Radiology, vol. 80,No. 2, pp. 258-260, February 1963, direct percutaneous non-catheter leftand right brachiolaugiography was described, wherein the injection sitewas below the arterial network around the eblow. In this technique, theinjection site is in the antecubital fossa. In other instances,injections can be made in the femoral artery depending on the areaselected for radiological examination. In the development of thesetechniques it has been found necessary in many instances to makemultiple injections Within a relatively short period of time. Arecurring problem with these procedures is the removal of air from thecontrast material prior to making the injections.

It is an object of this invention, therefore, to provide a means wherebymultiple injections may be given to the same patient without reloadingthe syringe.

Another object of this invention is the provision of a means wherebyentrapped air in the contrast material is removed from the syringe priorto making the injection.

Still another object of this invention is the provision of an apparatuscapable of injecting materials at pressures up to and exceeding 800 psiwhich is economical and of simple construction.

Still another object of this invention is the provision of an apparatuswhereby the operation of the seriograph and the X-ray apparatus issynchronized with the injection.

Still other and further objects will occur to those skilled in the artfrom a review of the drawings and the detailed description whichfollows.

Referring now to the drawings:

FIG. 1 is a side elevation of my injection device.

FIG. 2 is an end view taken along lines 22 of FIG. 1.

FIG. 3 is a vertical cross-sectional View taken along lines 3-3 of FIG.1.

FIG. 4 is a vertical cross-sectional view taken along lines 4-4 of FIG.1.

FIG. 5 is a fragmentary horizontal section of my 3,313,291 Patented Apr.11, 1967 device which illustrates the relation of the plunger assemblyto the movable stop member and particularly to the switching mechanismduring a stroke of said plunger.

FIG. 6 is a side elevational view partially in section, illustrating therelation of the movable stop members relative to the plunger shaftassembly and the piston rod assembly.

The apparatus of this invention comprises a frame 'which includes afront plate 1, a first transverse plate 2, a second transverse plate 3,and a rear plate 4. The front plate and the second transverse plate areconnected together by side rail members 5 and 8 in which the head of therail member 5 is on the rear of the second transverse plate 3, and whichis secured to the front of the front plate 1 by nut 6 in a similarmanner. The head 10 of rail member 8 is disposed beyond secondtransverse plate 3 and is secured by nut 9 to the front plate. A thirdrail member 11 runs from the first transverse plate 2 to the front plate1 and is secured thereto by means of nut 12. Additionally, the frontplate is secured at the bottom to bottom plate 13 which runs the lengthof the apparatus to rear plate 4. Secured to the bottom plate is footmember 14 which disposes the entire apparatus at a slight angle from thehorizontal surface on which it rests. Therefore, the front of theapparatus is slightly higher than the rear of the apparatus for purposeswhich will be hereinafter set forth. As will be noted by examination ofFIGS. 2 and 3, the front plate 1 and the first transverse plate 2contain cradling slots in the center for provision of the syringe barreland nozzle 18 and 19, respectively. Thus, slot 15 in the front plate 1is comparatively narrow so that nozzle 19 projects therethrough. Slot 16in first transverse plate 2 is wider and is arcuate in shape at thebottom for the provision of barrel 18 of the syringe. Projecting fromnozzle 19 into the syringe barrel 18 (see FIG. 5) is the tubular member20 which has an orifice 21 on its bottom surface. The outlet orifice 22thus communicates between the orifice 21 with the internal surface ofthe syringe barrel. The tubular member 20 terminates on the outside witha threaded member 23 for provision of a coupling .24 for hose 25 towhich a needle may be attached by conventional coupling means. Near thefront of the syringe barrel 18 is a free space 26 which is bounded tothe rear by annular shoulder 27 which acts to stop the stroke of plungerhead 28. Thus, it will be seen that due to the angular disposition ofthe syringe barrel 18 and the free space 26, any air which is in thesyringe will rise to the top and thus communicate by means of outletorifice 79 of the needle valve 75. Thus, by manipulation of knob 76 thevalve shaft 77 may be opened to allow any entrapped air to be removedthrough valve opening 78. In the event that all of the air is notremoved, there remains about 30 cc. of liquid in the syringe in the freespace 26 and, due to the lighter density of the air, this rises to thetop and is not injected through orifice 21 through tubular member 20 tothe outlet orifice 22, thus eliminating any appreciable danger ofinjecting air into the patients vascular system.

Slidably positioned in the syringe barrel 1% is the plunger assembly,including plunger head 28, plunge-r shaft 29, which is marked withcalibrations 3t and which terminates with a circular flange 31 at theend of shaft 29. It will be noted that, due to the centrally disposedcradling slots in the front and first transverse plates 1 and 2, theentire syringe may be easily removed from the apparatus to be cleanedand sterilized.

The plunger assembly is driven by a pneumatic cylinder 32 which issecured at the rear to the rear plate 4 by cylinder housing 33, and atthe front to the second transverse plate 3 by cylinder housing 34.Support rails 35 and 36 connected to transverse plate 3 and rear plate 4support the cylinder in operative relation so that the piston rod 37which terminates in a circular flange 38 is in abutting relation withflange 31 of the plunger shaft. Connected through cylinder housing 33 isthe air inlet connection 39 terminating in nipple 40 to which air line41 is attached. Air line 41 is connected to a toggle valve of standardconstruction 42 which, in turn, is connected to air line 43 to the gascylinder 44. The flow of gas from the cylinder is controlled by handvalve 45 through reducing valve 46 to high pressure gauge 47 and to lowpressure gauge 48. Thus, it is possible to reduce the pressure of thegas coming from the cylinder from about 1800 p.s.i.g. to through the useof reducing valve 46. Normally, gas pressures in the range of 80 to 100p.s.i. are used with the apparatus of this invention. Therefore, bymanipulation of toggle valve 42, the piston rod 37 is extended, thusdriving the plunger shaft 29 by reason of the abutting relationship ofthe plunger shaft flange 3-1 with the: piston rod flange 38.

In the particular embodiment shown, the area of the piston head 49 inthe cylinder 32 is approximately four times the area of the plunger head28, therefore, allowing for a mechanical advantage of about 4 to 1. Inthis manner, with a gas pressure of about 100 p.s.i. the contrastmaterial is ejected from the syringe at a pressure of about 400 psi.

The stroke of the piston and plunger assembly is limited by means ofmovable stop 50 which consists of a metal block assembly mounted onrails and 8, respectively, and which contains a traveling nut 51 at thebottom. The block portion of the movable stop 50 contains a centralopening 52 which is large enough to accommodate the flange portions 31and 38 of the piston and plunger assemblies. The block portion containsa front and rear transverse slot 53 and 54 into which stop plates 55 and56 may be slidably positioned. Projecting through the traveling nutportion 51 is a Worm shaft 57 which is journaled in collars 58 and 59 ofthe second transverse plate and the rear plate, respectively, and whichis connected to a crank member 60 and crank handle 61. It is, therefore,possible by manipulation of the crank to move the entire movable stopassembly axially in either direction along the side rails 5 and 8 of theframe.

Referring now to FIGS. 1 and 5, the switching mecha nism contained inhousing 65 consists of a stop plate 62 which is adapted to slidably fitinto transverse slots 53 or 54 of the movable stop assembly 50. On theback portion of the stop plate 62 is a depression 63. Attached to stopplate 62 is a pair of guide rods 64 connected by connecting member 81,upon which housing 65 is slidably positioned, and which is secured in aparticular position by set screw 66. Below the guide rod 64 andextending through the stop plate 62 is a slidable cam shaft 67 which isbiased against spring member 80 and which has an annular restrictedportion 68 and a cam surface 69. The cam follower 70 is supported onbracket 71 so as to open switch 72 when the follower is in position overthe restricted portion 68 of the cam shaft. Contact of the cam follower70 with the cam surface 69 closes switch 72 and thus actuates theseriograph and X-ray apparatus. The striking plate 73 is located at theend of the slidable cam shaft 67 and contains a pointer 74 at itslowermost end so that the apparatus may be positioned at any positionalong the calibrated plunger shaft 29. Upon contact of the flange 31 ofthe plunger shaft with the striking plate 73, the switch 72 is closed byreason of the contact of the cam follower 70 with the cam surface 69,thus energizing the seriograph and X-ray apparatus to produce multipleexposures.

It will be noted in the embodiment illustrated in FIG. 5 that thestriking plate 73 has been set to be contacted by the flange 31 of theplunger shaft after about 10 cc. of fluid has been injected. In otherwords, the plunger will have moved from its position to the pointindicated by the pointer 74 prior to the closing of switch 72 to actuatethe seriograph. This offers certain advantages in that it is sometimesdesirable to start the exposure an instant or two after the initialinjection to enable the bolus of injectable material to reach thedesired area of the vascular system. Thus, for example, if the injectionwere in the brachial artery, it would require more time for the fluid toreach the carotid artery than it would to reach the area of thesubclavian artery. Thus, with the movable switching arrangement wherebythe entire housing can be moved to actuate the switch at any desiredpoint after injection of any desired amount of contrast material, it ispossible for the operator to have precise control over the manner ofexposure required for a particular radiological examination. It will benoted that the striking plate 73 fits into the recess 63 of stop plate62 when the plunger assembly has gone the limited stroke.

Operation In the operation of the device, it is first necessary to loadthe previously sterilized syringe. This is accomplished by placing theflange members 31 and 38 into abutment and thereafter moving the crankto place the movable stop 50 so that the two flange members are locatedbetween the first and second transverse slots 53 and 54, respectively.This is best illustrated in FIG. 6. Thereafter, the stop plates 55 and56 are positioned into the transverse slots. The crank is then moved soas to force the plunger head 28 forward to annular shoulder 27. Theneedle attached to tube 25 is inserted into the contrast material andthe crank handle 61 is then turned in the other direction to move theplunger assembly toward the rear and thus draw contrast material intothe barrel 18 of the syringe. Normally, the syringe is loaded so thesyringe contains about 35 cc. material more than is required for aparticular series of injections. The crank handle 61 is then turned inthe other direction after the knob 76 of the valve stem 77 ismanipulated to open valve opening 78. The plunger assembly is movedforward until contrast material is seen to be coming out of valveopening 78. Thereafter, the knob 76 is turned to seat valve stem 77 onseat valve not shown. Stop plate 56 is then removed and the movable stop50 is moved until stop plate 55 registers upon the calibration desiredfor the injection.

It is possible to load the syringe by the use of only one transverseslot and one slidable plate in the movable stop 50. Assuming this slotto be 54 and the plate to be 56 as illustrated in FIG. 6, the abuttingflanges 31 and 38 can be moved forwardly to expel air from the syringe.Thereafter the plate 56 is removed and stop 50 is moved forwardly sothat slot 54 is in the position shown in FIG. 5. Plate 56 is theninserted in slot 54 and stop 50 is moved rearwardly to load the syringe.The plate 56 is removed and the stop 50 is moved rearwardly to theposition shown in FIG. 6 and the plate 56 is reinserted. The stop 50 isthen moved forwardly so that plate 56 pushes the plunger flange 31 andthe piston rod flange 38 for wardly until liquid is expelled throughneedle valve 75. The needle valve is then closed and the plate 56 isagain removed and the entire stop 50 is moved forwardly to the point onthe calibrated shaft 50 desired for an injection. Plate 56 is insertedinto slot 54 and the apparatus is ready for the first injection. It willbe noted that, due to the slight angle of the syringe barrel, due to thefoot 14 attached to the bottom plate 13, air having a lower density thanthe contrast material is thus concentrated in the upper end of thesyringe barrel or area 26. Thereafter, by moving the plunger headforward, all the air is removed through the needle valve 75 prior tomaking the first injection. As a safety factor, the injectable materialleaves via orifice 21 and tube 22 which is located in the lower portionof the free space 26; therefore, in the event that any entrapped air isstill Within the syringe it will be concentrated at the top of freespace 26 and thus will not be injected into the patient.

After the stop plate 55 has been accurately placed at the desired pointalong the calibrated shaft, the gas valve 45 is open and reducing valve46 is set so that the pressure registering on gauge 48 is about 100pounds. The needle is then inserted into the artery of the patient.Thereafter, the toggle valve 4-2 is opened and the pressurized gasforces the piston within cylinder 32 forward so that by means of theabutting relationship of piston flange 38 and plunger flange 31, theplunger shaft 30 and plunger head 28 is pushed forward until stopped bystop plate 55. Thus, an injection of any pre-determined size may bemade. The toggle valve may be closed at will so that the exhaustpressure orifice is opened some time after the injection is made, so asnot to frighten the patient. Should it be desired to make anotherinjection, it is merely necessary to move the movable stop Sil bymanipulation of crank 66 to another point on the calibrated shaft andthereafter open toggle valve 42 to make another injection. As previouslyindicated, it is possible to use stop plate 62 rather than stop plate 55and to set the housing 65 at any desired point along rod members 64.Therefore, the striking plate 73 can be set so as to be contacted afterinitial injection of cc. of material has been made, the stop plate 62serving to stop the full stroke of the plunger in the manner previouslyindicated. It is thus possible to make a series of inject-ions within amatter of seconds, each injection being of predetermined size and tosynchronize the seriograph and X-ray apparatus to start the exposures atany pre-determined point during the course of the injection.

Many modifications will appear to those skilled in the art from theforegoing detailed description, which is intended to be illustrative andnot limiting, except so as to be commensurate in scope with the appendedclaims.

What is claimed is:

1. A power-driven medical apparatus, adapted for use in percutaneousnon-catheter angiography, which comprises;

(a) a frame;

(b) a diagnostic medical syringe mounted on said frame and including:

(i) a barrel having an outlet orifice and including a plunger assemblyslidably mounted for axial reciprocation therein;

(ii) said plunger assembly comprising a head portion and a shaft inwhich one end of said shaft is connected to said head portion, and theother end of the shaft extends outside of said barrel;

e) a cylinder including a piston assembly slidably mounted for axialreciprocation in said cylinder and a gas orifice;

(i) said piston assembly including a head portion and a rod in which therod is connected to said head portion at one end with the free endextending outside of said cylinder, said free end being positioned inoperative relation with the shaft of said plunger assembly to drivesame;

(d) a source of compressed gas connected to said gas orifice and valvemeans for controlling the flow of gas to said orifice; and

(e) a movable stop mounted for axial movement on said frame tophysically stop the full stroke of the piston rod and plunger assembly,so that by movement of said stop, sequential injections can be madewithout reloading the syringe.

2. A power-driven medical apparatus, adapted for use in percutaneousnon-catheter angiography, which comprises;

(a) a frame;

(b) a diagnostic medical syringe mounted on said frame and including;

(i) a barrel having an outlet orifice and containing a plunger assemblyslidably mounted for axial reciprocation therein,

(ii) said plunger assembly comprising a head portion and a shaft inwhich one end of said shaft is connected to said head portion and theother end of the shaft extends outside of said barrel;

(c) a cylinder, including a piston assembly slidably mounted for axialreciprocation in said cylinder and a gas orifice,

(i) said piston assembly including a head portion and a rod in which therod is connected to said head portion at one end with the free endextending outside of said cylinder, said free end being positioned inoperative relation with the shaft of said plunger assembly to drivesame;

(d) a source of compressed gas connected to said gas orifice and valvemeans for controlling the flow of gas to said gas orifice;

(e) a calibrated means to measure the amount of liquid in said syringe;and

(f) a movable stop mounted for axial movement on said frame in visualrelation to said calibrated means to physically stop the full stroke ofthe piston rod and plunger assembly so that by movement of said stop,sequential injections of predetermined size can be made Withoutreloading the syringe.

3. A power-driven medical apparatus adapted for use in percutaneousnon-catheter angiography, which comprises;

'(a) a frame, said frame comprising a front plate member and a backplate member and side rail members;

(b) a diagnostic medical syringe mounted on said frame and including:

(i) a barrel having an outlet orifice and containing a plunger assemblyslidably mounted for axial reciprocation therein,

(ii) said plunger assembly comprising a head portion and a shaft inwhich one end of said shaft is connected to said head portion, and theother end of the shaft extends outside of said barrel;

(0) a cylinder including a piston assembly slidably mounted for axialreciprocation in said cylinder and a gas orifice,

(i) said piston assembly, including a head portion and a rod in whichthe rod is connected to said head portion at one end with the free endextending outside of said cylinder, said free end being positioned inoperative relation with the shaft of said plunger assembly to drivesame;

(d) a source of compressed gas connected to said gas orifice and valvemeans for controlling the flow of gas to said orifice; and

(e) a movable stop mounted on said rail members for axial movementthereon, to physically stop the full stroke of the piston rod andplunger assembly, so that by movement of said stop, sequentialinjections can be made without reloading the syringe.

4. A power-driven medical apparatus adapted for use in percutaneousnon-catheter angiography, which comprises;

(a) a frame, said frame comprising a front plate member, an intermediatetransverse plate member, and a rear plate member in which said frontplate member and said intermediate plate member contain cradling slots;

(b) a diagnostic medical syringe detachably cradled in said slots ofsaid front and intermediate transverse plate members, which comprises;

(i) a barrel having an outlet orifice and containing a plunger assemblyslidably mounted for axial reciprocation therein,

(ii) said plunger assembly comprising a head portion and a shaft inwhich one end of said shaft is connected to said head portion, and theother end of the shaft extends outside of said barrel;

(c) a cylinder including a piston assembly slidably mounted for axialreciprocation in said cylinder and a gas orifice,

(i) said piston assembly, including a head portion and a rod in whichthe rod is connected to said head portion at one end, with the free endextending outside of said cylinder, said free end being positioned inoperative relation with the shaft of said plunger assembly to drivesame;

(d) a source of compressed gas connected to said gas orifice and valvemeans for controlling the flow of gas to said orifice; and

(e) a movable stop mounted for axial movement on said frame tophysically stop the full stroke of the piston rod and plunger assembly,so that by movement of said stop, sequential injections can be madewit-bout reloading the syringe.

5. A pressure medical injector adapted for use for injectingradio-opaque liquid in the technique of angiography, which comprises;

(a) a frame,

(b) a diagnostic medical syringe, including a barrel having a plungerassembly slidably mounted therein for axial reciprocation,

(i) said barrel being mounted in said frame so that the front portion ofthe barrel is slightly elevated over the rear portion of the barrel,

(ii) said bar-rel having an escape valve mounted on the top and at thefront thereof, which communicates with the inside of the barrel,

(iii) said barrel having an outlet orifice in the front thereof, saidorifice being located in the lower portion of the front of said barrel,

(iv) said barrel being constricted on its internal surface near thefront end, so as to physically prevent the plunger assembly going fullstroke; and

(c) power means adapted to propel the plunger axially, whereby liquidcontained in said barrel may be ejected under pressure.

6. A power driven medical apparatus as defined in claim 1, in which:

(a) said free end of said plunger shaft and said free end of said pistonrod each contain flange members, adapted to fit in abutting relation;

(b) said movable stop comprises a block having an opening in the centerthrough which the piston rod and the shaft of the plunger can move andwhich contains:

(1) two transverse slots, and

(2) two plates slidably positioned in said slots to engage with theflange members of said plunger shaft and said piston rod; and

(c) means for moving said block axially in either direction so as toextend the shaft of said plunger and retract the rod of said piston toload the syringe and thereafter to move the entire stop forward to expelair from the syringe.

7. A power driven medical apparatus as defined in claim 1, in which:

(a) said movable stop contains an opening in the center through whichthe piston rod and the shaft of the plunger can move and which containsat least one transverse slot;

(b) the further combination therewith of a switch and a switch actuatingmechanism;

(1) said switch actuating mechanism comprising;

(a) a plate slidably positioned in said slot;

(b) an adjustable cam shaft extending through said plate, said cam shaftbeing responsive to the movement of said piston rod and plunger shaft;and

(c) a cam follower mounted in operative relation with said switch andsaid cam shaft;

(d) so that movement of said piston rod and plunger shaft moves said camshaft and said cam follower follows the surface of said cam shaft toactuate said switch.

8. A power driven medical apparatus as defined in claim 1, in which:

(a) said movable stop comprises a block having an opening in the centerthrough which the piston rod and the shaft of the plunger can move,

(1) said block containing a transverse slot;

(b) a plate slidably positioned in said slot and engageable with saidpiston rod and said shaft of said plunger to limit the stroke of each;and

(c) means for moving said block axially in either direction along saidframe.

9. A pressure medical injector as defined in claim 5,

in which:

(a) said outlet orifice comprises a hollow tubular member which projectsinto said barrel,

(1) said tubular member being closed at the end located inside thebarrel and containing an orifice near the closed end and on theunderside thereof.

References Cited by the Examiner UNITED STATES PATENTS 2,602,446 7/1952Glass et al. l282l8 2,734,504 2/1956 Crescas et al l282l8 2,896,6217/1959 Rodrigues l282l8 3,156,236 10/1964 Williamson 1282.05

References Cited by the Applicant UNITED STATES PATENTS 2,865,37112/1958 N. Dorbecker et al.

ROBERT E. MORGAN, Acting Primary Examiner. SIMON BRODER, Examiner.

1. A POWER-DRIVEN MEDICAL APPARATUS, ADAPTED FOR USE IN PERCUTANEOUSNON-CATHETER ANGIOGRAPHY, WHICH COMPRISES; (A) A FRAME; (B) A DIAGNOSTICMEDICAL SYRINGE MOUNTED ON SAID FRAME AND INCLUDING: (I) A BARREL HAVINGAN OUTLET ORIFICE AND INCLUDING A PLUNGER ASSEMBLY SLIDABLY MOUNTED FORAXIAL RECIPROCATION THEREIN; (II) SAID PLUNGER ASSEMBLY COMPRISING AHEAD PORTION AND A SHAFT IN WHICH ONE END OF SAID SHAFT IS CONNECTED TOSAID HEAD PORTION, AND THE OTHER END OF THE SHAFT EXTENDS OUTSIDE OFSAID BARREL; (C) A CYLINDER INCLUDING A PISTON ASSEMBLY SLIDABLY MOUNTEDFOR AXIAL RECIPROCATION IN SAID CYLINDER AND A GAS ORIFICE;